The role of physical design and informal communication

ecause as a visitor entered the unit and needed information about the location or
status of a patient, the first encounter they had was with staff at the three large
rectangular desks in the front of the unit (Desks B1). Recall that the people at these
desks, often physicians and members of allied health, would not readily have this
information available. Consequently, physicians were interrupted during
documentation to redirect visitors to the back of the unit to speak with the charge
nurse. Nurses’ work flow was also frequently disrupted for the same reason. The
initial observations made by the NM revealed that the CN and UR should be
repositioned to the front of the unit at Desk B1 to better serve visitors (Figure 14). As
a result of this change, doctors began to unofficially claim the now quieter Desk B2 as
their location for documentation tasks, which led to fewer interruptions and
distractions. It is important to note that this change occurred over time between mid
and late February, and thus the locations of “charge nurse” and “nurses station”
became somewhat blurred for a time. Consequently, the information collected by the
CWM tool concerning these two locations after the change may be inaccurate to some
extent.
The second physical change made by the new NM was the relocation of the
patient charts. Before the change, the charts sat in a large, tall rotating chart carousel
on Desk A1. This carousel was large enough that it reduced visibility across the unit.
Recognizing seemingly minor design factor as a significant obstacle to communication
and sense of cohesion, the NM moved the charts out of the major lines of sight to
location A2 on a wall-mounted organizer (Figure 15). One nurse described the
increased visibility that resulted:
“It didn’t seem like a big deal when they (the charts) were there,
but as soon as they were gone, it seemed less cluttered. It seemed like
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